Alcalde-Rabanal Jacqueline Elizabeth, Nigenda Gustavo, Bärnighausen Till, Velasco-Mondragón Héctor Eduardo, Darney Blair Grant
Center for Health Systems Research, National Institute of Public Health - Instituto Nacional de Salud Pública, Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, CP 62100, Cuernavaca, Morelos, Mexico.
Partners in Health, Calle Primera Poniente Sur # 25, Angel Albino Corzo, CP 30370, Chiapas, Mexico.
Hum Resour Health. 2017 Aug 3;15(1):49. doi: 10.1186/s12960-017-0220-5.
The purpose of this study was to estimate the gap between the available and the ideal supply of human resources (physicians, nurses, and health promoters) to deliver the guaranteed package of prevention and health promotion services at urban and rural primary care facilities in Mexico.
We conducted a cross-sectional observational study using a convenience sample. We selected 20 primary health facilities in urban and rural areas in 10 states of Mexico. We calculated the available and the ideal supply of human resources in these facilities using estimates of time available, used, and required to deliver health prevention and promotion services. We performed descriptive statistics and bivariate hypothesis testing using Wilcoxon and Friedman tests. Finally, we conducted a sensitivity analysis to test whether the non-normal distribution of our time variables biased estimation of available and ideal supply of human resources.
The comparison between available and ideal supply for urban and rural primary health care facilities reveals a low supply of physicians. On average, primary health care facilities are lacking five physicians when they were estimated with time used and nine if they were estimated with time required (P < 0.05). No difference was observed between available and ideal supply of nurses in either urban or rural primary health care facilities. There is a shortage of health promoters in urban primary health facilities (P < 0.05).
The available supply of physicians and health promoters is lower than the ideal supply to deliver the guaranteed package of prevention and health promotion services. Policies must address the level and distribution of human resources in primary health facilities.
本研究旨在评估墨西哥城乡基层医疗设施在提供预防和健康促进服务保障套餐方面，现有和理想人力资源（医生、护士和健康促进人员）供应之间的差距。
我们采用便利抽样进行了一项横断面观察性研究。我们在墨西哥10个州的城乡地区选取了20家基层医疗机构。我们使用提供预防和促进服务所需、已用和可用时间的估计值，计算了这些机构中人力资源的现有和理想供应量。我们使用Wilcoxon和Friedman检验进行描述性统计和双变量假设检验。最后，我们进行了敏感性分析，以检验时间变量的非正态分布是否会使人力资源现有和理想供应量的估计产生偏差。
城乡基层医疗机构现有和理想供应量的比较显示，医生供应不足。平均而言，按已用时间估计，基层医疗机构缺少5名医生；按所需时间估计，则缺少9名医生（P < 0.05）。城乡基层医疗机构护士的现有和理想供应量均未观察到差异。城市基层医疗机构的健康促进人员短缺（P < 0.05）。
在提供预防和健康促进服务保障套餐方面，医生和健康促进人员的现有供应量低于理想供应量。政策必须解决基层医疗机构人力资源的水平和分布问题。
